Bone Plate

ABSTRACT

A bone plate includes (a) a body having a first surface which, in an operative configuration, faces away from a bone on which the plate is to be mounted and a second surface, which in the operative configuration, faces the bone, the body including a first section extending along a first longitudinal axis and a second section extending along a second longitudinal axis angled with respect to the first longitudinal axis; (b) a first hole extending through the body from the first surface to the second surface and defining a first hole axis, the first hole being structured to lockingly engage a head of a first bone anchor inserted therein such that a shaft of the first bone anchor extends along the first hole axis; and (c) a second hole extending through the body and spaced apart from the first hole. The second hole defines a second hole axis and is structured to lockingly engage a head of a second bone anchor inserted therein such that a shaft of the second bone anchor extends along the second hole axis. The first and second hole axes defines a single plane and intersecting at a point on a side of the bone plate facing the second surface.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No.13/930,411 filed Jun. 28, 2013, which is a continuation of U.S. patentapplication Ser. No. 13/092,625, filed on Apr. 22, 2011, which is acontinuation of U.S. patent application Ser. No. 10/843,113, filed onMay 11, 2004, now Pat. No. 7,951,176, which in turn claims priority toU.S. Provisional Patent Application Ser. No. 60/474,279, filed on May30, 2003.

TECHNICAL FIELD OF THE INVENTION

The present invention relates generally to bone plates, and morespecifically, to bone plates for the fixation of parts of a fracturedbone, preferably long bones, including the femur and the tibia.

BACKGROUND OF THE INVENTION

A bone plate is a plate that is fastenable to the surface of a bonetypically at both sides of a fracture to support and/or stabilize thefracture. Bone plates have typically been attached to the bone with bonescrews that extend from the plate into the bone. In some examples, thehead of the bone screw is locked to the plate (e.g., by threadedengagement between the screw head and the bone plate) and in otherplates the head of the screw is free to angulate with respect to theplate, such that the screw may be placed in the bone at asurgeon-selected angle. In yet other examples, the screw head maycooperate with the bone plate to provide compression or distraction ofthe fracture (i.e., to push the bone fragments towards or away from oneanother).

When treating certain types of fractures, such as that of the proximalportion of the femur, there may be high stresses at the bone-screwand/or screw-plate interfaces. Several different types of bone plateshave been developed to accommodate these high stresses. In one exampleknown as a “blade plate,” the bone plate may have a blade-shaped portionthat extends approximately perpendicularly to the plate, and extendsinto a channel formed in the bone through the fracture site. In anotherexample, a lag screw may extend from a barrel portion of the plate andthrough the fracture site. With both of these systems, however, a largeamount of bone must be removed to accommodate the blade or barrel. Inaddition, the surgical procedures are technically difficult, as the bonemust be removed with precision in order to allow proper positioning ofthe bone plate on the bone.

SUMMARY OF THE INVENTION

The present invention in one embodiment is directed to a bone platehaving a longitudinal axis and comprising an upper surface, a lowersurface, a first hole for engaging an end portion of a first boneanchor, the first hole being configured and adapted to fix a shaft ofthe first bone anchor along a first axis, and a second hole spaced apartfrom the first hole along the longitudinal axis, the second hole forengaging an end portion of a second bone anchor and configured andadapted to fix a shaft of the second bone anchor along a second axis.The first hole and the second hole may be configured such that the firstaxis and the second axis define a single plane and intersect at a pointbelow the lower surface of the bone plate. The bone plate may furtherinclude a third hole for engaging an end portion of a third bone anchorsuch that a shaft of the third bone anchor is fixed along a third axis,wherein the third hole preferably is located between the first andsecond holes and the third axis lies at an angle relative to the planedefined by the first and second axes. The first, second, and third holesmay be positioned along the longitudinal axis of the bone plate. A shaftof the first bone anchor may contact or nearly contact a shaft of asecond bone anchor. The first, second and third bone anchors may be bonescrews, blades, or other anchors known to one of ordinary skill in theart for engaging bone.

According to one illustrative embodiment, the plane defined by the firstand second axes may lay at an angle relative to a plane bisecting thebone plate along the longitudinal axis and or the central axis.Additionally or alternatively, the first and second holes may beconfigured such that the first and second axes define an acute angle atthe point of intersection.

Preferably, at least one of the first and second holes may be threadedto engage threads on the end portion of a bone screw, or alternatively,at least one of the first and second holes may be dimensioned andconfigured for an end of a bone screw to be press fit therein.Preferably, at least one of the first and second holes are configured sothat the bone anchor will be fixed to the bone plate when engagedtherewith at a predetermined angle with respect to the plane formed bythe lower surface of the bone plate at the location of the respectivehole. The angle formed between the lower surface of the bone plate andthe axis of one of the bone anchors may be approximately perpendicular,and optionally the angle between the axis of the second bone anchor andthe lower surface forms an acute angle. More preferably, the angles ofthe axes of the bone anchors which are predetermined by the nature ofthe bone anchors engagement with the respective hole, are such that thebone anchors will form a truss formation. More preferably, at least oneor more holes in the bone plate are oriented such that bone anchorsengaged in the bone plate are fixed, and at least a first bone anchor,preferably its tip, contacts at least a second bone anchor along thelength of the second bone anchor.

The bone plate may also include at least one combination hole forreceiving a bone screw, the combination hole having a first portion anda second portion, wherein the first portion defines a substantiallycircular outer periphery defining a first center point, and the secondportion defines an elongated outer periphery that defines a secondcenter point. The elongated outer periphery may be elongated in adirection substantially parallel to the longitudinal axis of the plate,and the second portion may overlap the first portion. A plurality ofthreads may be disposed on the first portion of the combination hole forthreadably engaging the head of a bone screw. The second portion of thecombination hole may be configured and dimensioned to engage asubstantially spherical head of a bone screw.

The present invention in another embodiment is also directed to boneplating systems including a bone plate and various combinations of boneanchors (e.g., bone screws, blades, etc.). The bone plate may alsoinclude a first end and a second end, in which the first end isconfigured for following the contour of the bone. The first end mayinclude a hook configured to engage bone tissue. The hook may include anedge located below the lower surface of the bone plate for penetratinginto bone tissue. The edge of the hook may be formed by two spaced aparttalons.

The bone plate may also comprise a first section having a firstlongitudinal axis, a second section defining a second longitudinal axis,and a transition section connecting the first section to the secondsection such that an included angle is defined between the firstlongitudinal axis and the second longitudinal axis. The included anglebetween the first and second longitudinal axes may be obtuse, acute orapproximately right angled. The first section, the second section andthe transition sections may be integral with one another made from asingle piece of material, or alternatively joined together by techniquesknown to one of ordinary skill in the art. Additionally, the firstsection may be longer than the second section, and the transitionsection may connect the first section to the second section such thatthe bone plate is substantially L-shaped or T-shaped. The transitionsection may also be bent or twisted to connect the first section to thesecond section which may locate the second section in a plane differentfrom that of the first section. The upper surface of the transitionsection may be substantially S-shaped. The lower surface of the first,second and transition sections may also define radius of curvature alongtheir longitudinal axes.

The present invention is also generally directed to a method of using abone plate according to the present invention for reducing bonefractures. The method comprises the steps of affixing an embodiment of abone plate according to the present invention across the gap of afracture zone and engaging the threaded head of a bone screw in athreaded hole of the bone plate so as form a threaded locked engagement.The threaded hole is configured for threaded locked engagement with thethreaded head of the bone screw. The threaded hole may fix the bonescrew along an axis at such an angle relative to the lower surface ofthe bone plate such that upon the threaded locked engagement of the bonescrew with the bone plate, the gap of the bone fracture is reduced.

BRIEF DESCRIPTION OF THE DRAWINGS

To facilitate an understanding of the characteristics, structure andoperation of the invention, preferred exemplary features of theinvention are described in the accompanying discussion, it beingunderstood that the invention in its various embodiments is not limitedto the preferred examples illustrated and, wherein similar referencecharacters denote similar elements throughout the several views orembodiments, and wherein:

FIG. 1 is a side view of a first illustrative embodiment of a bone plateaccording to the present invention, shown attached to a proximal portionof a fractured femur by a plurality of bone screws;

FIG. 2 is a top view of a portion of the bone plate of FIG. 1;

FIG. 3 is a cross-sectional view of a portion of the bone plate of FIG.1; taken along line of FIG. 2;

FIG. 4 is a perspective, partial view of the lower surface of the boneplate of FIG. 1, with a portion of the bone plate shown incross-section;

FIG. 5 is a front view of the bone plate of FIG. 1;

FIG. 6 is a perspective view of a bone screw having a threaded head foruse with a bone plate according to one embodiment of the presentinvention;

FIG. 7 is a cross-sectional view of the bone screw of FIG. 6;

FIG. 8 is a plan view of a spiral blade for use with a bone plateaccording to one embodiment of the present invention;

FIG. 9 is a perspective view of the spiral blade of FIG. 8;

FIG. 10 is a plan view of the bone plate of FIG. 1 having an alternatebone screw configuration

FIG. 11A is a top view of a combination hole provided in a bone plateaccording to one embodiment of the present invention;

FIG. 11B is a cross-sectional view of the combination hole of FIG. 11A,taken along line XII-XII of FIG. 11A;

FIG. 12A is a top view of a different embodiment of a combination hole.

FIG. 12B is a cross-sectional view of the combination hole of FIG. 12A,taken along line A-A of FIG. 12A.

FIG. 13 is a cross-sectional view of another illustrative embodiment ofa bone plate according to the present invention;

FIG. 14 is a perspective, partial view of the lower surface of the boneplate of FIG. 13, with a portion of the bone plate shown incross-section;

FIG. 15 is a side view of a still further illustrative embodiment of abone plate according to the present invention;

FIG. 16 is a top view of the bone plate of FIG. 15;

FIG. 17 is a perspective partial view of the bone plate of FIG. 15;

FIG. 18 is a top view of another illustrative embodiment of a bone plateaccording to the present invention;

FIG. 19 is a cross-sectional, partial view of the bone plate of FIG. 18,taken along the line XIX-XIX of FIG. 18;

FIG. 20 is a cross-section, partial view of the bone plate of FIG. 18,taken along the line XX-XX of FIG. 18;

FIG. 21 is a perspective, partial view of the bone plate of FIG. 18;

FIG. 22 is a frontal, partial, perspective view of the bone plate ofFIG. 18;

FIG. 23 is a top perspective view a further illustrative embodiment of abone plate according to the present invention;

FIG. 24 is a perspective view of the bone plate of FIG. 23;

FIG. 25 is another perspective view of the bone plate of FIG. 23;

FIG. 26 is a further perspective view of the bone plate of FIG. 23;

FIG. 27 is yet another perspective view of the bone plate of FIG. 23;and

FIG. 28 is a cross-sectional view of one type of partially threaded boneplate hole, according to one embodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

For convenience, the same or equivalent elements in various embodimentsof the bone plate illustrated in the drawings have been identified withthe same reference numerals. Further, in the description that follows,any reference to either orientation or direction is intended primarilyfor the convenience of description and is not intended in any way tolimit the scope of the present invention thereto.

A first illustrative embodiment of a bone plate 10 is shown in FIG. 1.The bone plate 10 shown in FIG. 1 is dimensioned and configured forinternal fixation of the proximal portion of a fractured femur F. One ofordinary skill in the art will know and appreciate, however, that theprinciples of the present invention may be applied to bone plates forfixation of other bones of humans and/or animals, for example longbones, and for different parts of long bones (e.g., the proximal tibia,the distal femur, etc.).

As shown in FIGS. 1 and 2, bone plate 10 has a longitudinal axis 15, andincludes an upper surface 20 and a lower surface 22. Bone plate 10 maybe constructed from biocompatible materials such as, for example,titanium, alloys of titanium, stainless steel, resorbable materials, andallograft, although one of ordinary skill in the art will know andappreciate that any biocompatible material may be used. As will bediscussed in greater detail below and shown generally in FIGS. 1 and 3,bone plate 10 is configured to receive a plurality of bone anchors 110,115, 120, 125. Bone anchors 110, 115, 120 and 125 are shown in FIG. 1 asbone screws, however other types of bone anchors known to one ofordinary skill in the art, such as blades, nails, pins, etc, may beused. The engagement of the bone plate 10 and screws 110, 115 may resultin a truss formation 128 for effectively anchoring bone plate 10 to theproximal portion of a fractured femur, or other bone. Lower surface 22may contact the bone F directly, as shown, or alternatively, may be heldat a distance from the bone surface to facilitate increased flow ofblood over the fracture zone.

Now referring to FIG. 3, a cross-sectional view of bone plate 10 isshown. Bone plate 10 may include a first hole 24 and a second hole 28.First hole 24 may define a central axis 26 along which the shaft portionof a first bone anchor would extend, and second hole 28 may define acentral axis 30 along which the shaft of a second bone anchor wouldextend. First and second holes 24 and 28 may be configured such thatcentral axes 26, 30 define a single plane and intersect in that plane ata point 32 below the lower surface 22. The intersection of central axes26, 30 may define an angle a, which is preferably an acute angle, andmore preferably, between about 3° and about 60°. The central axis 26 ofthe first hole 24 may be substantially perpendicular to the lowersurface 22 of the bone plate 10 or to the exterior surface of the bone Finto which it is inserted. For example, central axis 26 may preferablybe oriented at about a 95° with respect to the lower surface 22 of thebone plate 10. The central axis 30 of the second hole 28 may be at anacute angle with respect to the lower surface 22 of the bone plate 10 orto the exterior of the bone F in which it is inserted. Bone plate 10 mayalso include at least two guide holes 18 as shown in FIGS. 3 and 4 forreceiving and guiding a wire.

First and second holes 24, 28 may each be configured for engaging thehead of a bone anchor. More preferably, first and second holes 24, 28may be configured for fixing and locking with the bone anchor and morepreferably for fixing the bone anchor in a fixed, predeterminedorientation with respect to the lower surface 22 of the bone plate 10 orthe exterior surface of the bone in to which it is inserted, forexample, by threaded engagement, interference or press fitting, or anyother form of joining the plate 10 with the screw heads known to one ofordinary skill in the art. The bone anchor is fixed to the plate suchthat its shaft or shank would extend along the central axes 26, 30 ofthe holes 24, 28 in the bone plate 10. In the illustrative embodimentshown in FIG. 3, holes 24, 28 are threaded for respective engagementwith bone anchors having threaded heads.

An example of such a bone anchor is shown in FIGS. 6 and 7. Bone screw100 defines a central axis 102, a shaft in the form of a threaded shank104 with tip 105, and a threaded head 106. Bone screw 100 may beconstructed from, for example, titanium, alloys of titanium, stainlesssteel, resorbable materials such as polymers, allograft or otherbiocompatible materials known in the art. Bone screw 100 is preferablycompatible with the bone plate 10 in terms of composition and strength.Bone screw 100 may be cannulated having a through bore or channel 107extending from the upper surface 103 head 106 to the tip 105, as seen inFIG. 7, for introducing instruments, for example, a guide wire into thefracture zone.

Another bone anchor that may be in a fixed and locked engagement withfirst and second holes 24, 28 is the spiral blade 310 shown in FIGS. 8and 9. Blade 310 defines a longitudinal axis 302 and has a proximal end306, a distal end 304 and an external surface 308 in the form of spiralflutes 307, although other configurations are possible. The spiral blade310 may be cannulated with a central channel 305, as shown, or may besubstantially solid. The proximal end 306 of blade 310 may be engaged infirst or second hole 24, 28 by press-fitting or interference fitting,although the present invention is not limited to any specific type ofjunction between the bone plate and the bone anchors.

Referring back to FIG. 3, threaded holes 24, 28 may be separatelyengaged by the threaded heads 106 of the bone screw 100 to form alocking threaded engagement between the plate and the threaded head 106,thereby aligning shanks 104, and central axis 102, along central axes26, 30. The internal thread pattern of threaded holes 24, 28 and thematching thread pattern of threaded head 106 may preferably have a screwthread profile having a 60° thread angle, but other thread patterns arepossible. The threaded engagement of the bone plate 10 and the threadedhead 106 prevents movement of bone plate with respect to bone screws 100engaged with threaded holes 24, 28, and locks the angular position ofcentral axes 102 with respect to the plate 10 and each other. Withthreaded shanks 104 of the bone screws anchored to the fractured boneand the threaded heads 106 lockingly engaged with the threaded holes 24,28, bone plate 10 is anchored to the bone. Depending upon the depth atwhich the threaded shank 104 is anchored into the bone, the lowersurface 22 of bone plate 10 may directly contact the bone surface, oralternatively, may be affixed and spaced at a distance from the bonesurface. In addition, wherein the shank 104 is of sufficient length soas to span across the gap of the fracture zone between the two fracturedsegments of bone F, either of the threaded holes 24, 28 and theircentral axes 26, 30 may align the shank 104 at such an angle withrespect to the plate 10 so as to reduce the gap of the fracture zoneupon locking of the threaded head 106 in the threaded hole 24, 28.

Referring again to FIGS. 1 and 3, because of the configuration ofthreaded holes 24, 28, in which their central axes 26, 30 intersect at apoint 32 below the lower surface 22 of bone plate 10, the threadedengagement of bone screws 110, 115 with threaded holes 24, 28 form atruss 128 beneath the bone surface. The truss formation serves toincrease the stability of the anchorage of bone plate 10 to thefractured bone. Additionally, the truss 128 serves to more evenlydistribute loads and stresses throughout the bone plate 10 and theanchoring bone screws 110, 115. These stresses would otherwise beconcentrated in the engagement between the threaded heads 106 of thebone screws 110, 115 and the bone plate 10. As shown in FIG. 1, withbone screws 110, 115 engaged with threaded holes 24, 28, bone screws110, 115 may contact one another at or near the point of intersection 32below the bone surface F. More preferably, the tip 105 of the secondbone screw 115 may contact the first bone screw 110 at the tip 105 ofthe first bone screw 110, as generally shown in FIG. 1 or at anotherlocation along the shank 104 of the first bone screw 110, as shown inFIG. 10. Alternatively, the bone screws 110, 115 may not contact oneanother; however their central axes 102 may intersect to define a planeand thereby operably associate the bone screws 110, 115 with one anotherto more evenly distribute the loads and stresses experienced at thethreaded screw head 106 to plate 10 interface.

As is shown in FIGS. 3 and 4, threaded holes 24, 28 may be conicallytapered in a direction from the upper surface 20 to the lower surface 22of bone plate 10. This tapering of the holes 24, 28 may facilitatealignment between the threads of holes 24, 28 and the threads on theheads 106 of bone screws 110, 115. Alternatively, threaded holes 24, 28may be substantially cylindrical, partially spherical or other shapesknown in the art. As is more clearly shown in FIG. 5, the central axes26, 30 of threaded holes 24, 28 may define a plane that intersects andlies at an angle β relative to a plane that substantially bisects thebone plate 10 and includes the longitudinal axis 15. According to onepreferred embodiment, the angle β may range from 0° to about 60°, orrange to about 15°, or from about 3° to about 6°, however other anglesare possible.

As shown in FIGS. 2 and 3, bone plate 10 may include a third hole 34defining a central axis 36 for engaging the head of a third bone anchor,shown for illustrative purposes in FIGS. 1 and 5 as bone screw 120.Third hole 34 may be similarly configured as threaded holes 26, 28 so asto include a thread for threaded engagement with the threaded head ofbone screw 120. Third threaded hole 34 may be conically tapered in thedirection from the upper surface 20 to lower surface 22 of bone plate10, or alternatively, threaded hole 34 may be substantially cylindrical,partially spherical or other shapes known in the art. Third threadedhole 34 may be located between threaded holes 24, 28. Referringspecifically to FIG. 5, the central axis 36 of the third threaded hole34 may intersect and lay at an angle δ relative to the plane defined bythe central axes 26, 30 of the first and second threaded holes 24, 28.Angle δ may range from about 0° to about 15°, or from about 5° to about8°, although other angles are possible. Referring to FIG. 2, threadedholes 24, 28, 34 may be located on and spaced relative to one anotheralong longitudinal axis 15.

The central axis 36 of the third hole 34 may be configured to intersectthe axis 26 of the first hole 24, and in addition or alternatively thecentral axis 36 may be configured to intersect the central axis 30 ofthe second bore hole 28. The third bone anchor 120 may contact the firstbone screw 110 at the tip 105 of the bone screw 110 or at anotherlocation along the shaft 104 of the first bone screw 110. Alternatively,or in addition there to, the third screw 120 may contact the second bonescrew 115 at its tip 105, or at some other location along the shank 104of the second bone screw 115. In one embodiment, the third bone screwmay contact both the first and second bone screw 110, 115, along theirrespective lengths, and all three bone screws may contact each other attheir respective tips 105.

Reference is now made to FIG. 28. In another embodiment, in lieu of, orin addition to, having any of the afore-described holes, the bone plate10 may have a partially threaded hole 90. The hole 90 may extend fromthe upper surface 20 to the lower surface 22 of the bone plate 10. Thediameters of the hole 90 at its uppermost surface and at its lower mostsurface may be equal or close to equal to each other. The hole may bewidest at the uppermost surface 20 and lowermost surface 22 of the plate10.

As shown in 28, the hole 90 may have three regions: an upper region 92,a middle region 94, and a lower region 96. The upper region 92 of thehole 90 may have an unthreaded inner surface 93 which, is preferablysmooth, although texturing may be provided. In a preferred embodiment,the upper region 92 may have a curved inward taper, preferably concave,more preferably spherical, from the top surface of the plate 10 to wherethe upper region 92 of the hole 90 meets the middle region 94. The upperregion 92 of the hole 90 is preferably narrowest where it meets themiddle region 94. In a preferred embodiment, the upper region maycomprise about 25% to about 35% of the thickness of the plate 10. In apreferred embodiment, the diameter of the upper region 92, at theregion's broadest point, may be about 6 mm and, at the region'snarrowest point, may be about 4 mm.

The middle region 94 of the hole 90 may have a threaded inner surface95. The threaded inner surface 95 may, in a direction from the uppersurface to the lower surface of the plate 10, have a conical inwardtaper. In a preferred embodiment, the threaded inner surface 95 maytaper at an angle α of approximately 5° to 15°, and preferablyapproximately 10°. The middle region 94 may be the narrowest region(i.e., smallest-diameter region) of the hole 90. In a preferredembodiment, the middle region 94 may comprise about 40% to 50% of thethickness of the plate 10. In a preferred embodiment, the diameter ofthe middle region 94 may vary only slightly (due to the relativelyshallow conical taper) and may be about 4 mm. The diameter or taper ofthe middle region 94 may of course vary depending upon the size and/ortaper of the screw.

The lower region 96 of the hole 90 may have an unthreaded inner surface97 which is preferably smooth, although texturing may be provided. In apreferred embodiment, the lower region 96 may, from where it meets themiddle region 94 to the lower surface of the plate, have a conicaloutward taper. In a preferred embodiment, the lower region 96 may taperoutwardly at an angle β of approximately 35° to 55°, and preferablyapproximately 45°. In a preferred embodiment, the lower region 96 maycomprise about 20% to 35% of the thickness of the plate. In a preferredembodiment, the diameter of the lower region 96, at the region'snarrowest point, may be about 4 mm and, at the region's broadest point,may be about 6 mm.

Different types of screws may be used with the hole 90. One type ofscrew is a screw that has a conically-tapered threaded head. Theexternal threads of the screw's head may mate with the internal threads95 of the middle region 94 of the hole 90. This threaded-head screw maybe inserted at only one angle (with respect to the plate), which may befixed by the threads 95 in the plate 10.

A second type of screw that may be used with the hole 90 is a screw witha threaded shaft, but with an unthreaded head. An unthreaded-head screwmay be inserted into hole 90 at any one of a number of angles. Theconical outward taper (shown at surface 97) of the lower region 96 ofthe hole 90 provides room for the screw shaft to be inserted at an anglewith respect to the center of the hole 90. Likewise, the curved inwardtaper of the upper region 92 of the hole 90 provides a seat (at surface93) for the screw head to rest in when an unthreaded-head screw isinserted at an angle. A threaded-head screw may be used with a coaxialcombination hole 90 in the same manner as the aforementionedunthreaded-head screw.

Although virtually any type of bone plate may benefit from coaxialcombination holes 90, coaxial combination holes are particularly usefulfor pubic symphysis plates and other relatively small bone plates.

Referring again to FIG. 1, bone plate 10 may include a first portion 6that is substantially planar and a second portion 8 that issubstantially curved for conforming to the head of a bone, such as theproximal portion of the femur F. Bone plate 10 may alternatively beconfigured as a straight plate, or additionally or alternativelyconfigured to include a flared portion in addition to a shaft portion.The lower surface 22 of first portion 6 may engage the bone surfacedirectly, in which instance first portion 6 may include a plurality ofrecesses 12 spaced about the longitudinal axis 15 for minimizing contactbetween the bone plate 10 and the bone surface to facilitate increasedblood circulation over the fracture zone. Threaded holes 24, 28 arepreferably located in the second portion 8 of bone plate 10 in which thesecond portion 8 conforms and follows the bone head.

Bone plate 10 may be provided with any number of holes as may besuitable for a specific surgical application. For example, as shown inFIG. 3, bone plate 10 may include one or more combination holes 38,which are substantially similar to the combination holes described inU.S. Patent Publication No. 2002/0183752 A1, incorporated herein byreference thereto. As shown in FIG. 11A, each combination hole 38includes a first, substantially circular portion 44, and a second,elongated portion 46. The circular portion 44 and the elongated portion46 overlap one another, and are thus in communication with one another.The outer periphery of circular portion 44 defines a first center point48, and a diameter D. The outer periphery of elongated portion 46defines a second center point 50. The outer periphery of elongatedportion 46 also defines a major axis 55 and a minor axis 57substantially perpendicular to the major axis 55. According to oneembodiment of the invention, major axis 55 may be substantially parallelto longitudinal axis 15 of the bone plate 10. In addition, major axis 55may lay along longitudinal axis 15 with first and second center points48, 50 located on longitudinal axis 15, however other configurations arepossible. Combination holes 38 may also be parallel but offset fromlongitudinal axis 15, and combination holes may be alternatively offsetwith respect to longitudinal axis 15.

Elongated portion 46 may be configured and dimensioned to engage asubstantially spherical screw-head of a bone screw (not shown).Additionally or alternatively, a conically shaped screw head, with orwithout threads, may engage the elongated portion 46. As shown in FIGS.11A and 11B, elongated portion 46 may have a concave, substantiallyspherical portion or recess 60 that opens toward upper surface 20 of thebone plate 10. When the shaft of a bone screw having a spherical head islocated eccentrically in elongated portion 46 (towards the right in FIG.10), the spherical head may engage recess 60 and bias the bone plate 10to provide compression of the bone fracture. In addition, a portion ofthe combination hole 38 may be concave along the lower surface 22 of thebone plate 10 to define a spherical recess 61.

Still referring to FIGS. 11A and 11B, circular portion 44 may beconfigured and dimensioned to engage the threaded head of a bone screw(not shown). An internal thread 62 may be provided on circular portion44. Thread 62 may be disposed in a single plane or in several planes.The plane(s) may be parallel to upper surface 20 and/or lower surface22. According to the illustrative embodiment shown, thread 62 extendssubstantially over the entire thickness of the bone plate from the uppersurface 20 to lower surface 22. The internal thread 62 may be formedover an angle of approximately 190° to approximately 280°. Referring toFIG. 1, combination hole 38 is shown engaged with a bone screw 125.

Reference is now made to FIG. 12A. In another embodiment, in lieu of, orin addition to, having combination hole(s) 38, the bone plate 10 mayhave at least one of a different type of combination hole 80. Eachcombination hole 80 may have two substantially circular portions 83 and84. The circular portions 83 and 84 may overlap one another, and be incommunication with one another.

An internal thread 87 may be provided on circular portion 83. Aninternal thread 88 may be provided on circular portion 84. Threads 87and 88 may extend substantially over the entire thickness of the boneplate from the upper surface 20 to the lower surface 22. FIG. 12B showsthread 88 of circular portion 84 extending the entire thickness of thebone plate. Threads 87 and 88 may be threaded in the same direction(e.g., requiring clockwise rotation for insertion of a screw with athreaded head) or in directions opposite from one another. Threads 87and 88 may be disposed in a single plane or in several planes. Theplane(s) of the threads may be parallel to upper surface 20 and/or lowersurface 22 of bone plate 10, or the plane formed by the threads may beangled with respect to the upper surface 20 and/or lower surface 22.Each thread of threads 87 and 88 may be formed over an angle ofapproximately 190° to approximately 270°. Threads 87 and 88 may extendover the same angle or at angles different from one another. Threads 87and 88 may have a conical inward taper. Combination hole(s) 80 may bepositioned within the bone plate 10 in the same way that combinationhole 38 may be positioned within the bone plate 10, as described above,or in different arrangements. In addition, combination holes 80 may beused in bone plates that also include combination holes 38, as well asany other hole described in the specification.

Shown in FIG. 13 is an alternative preferred embodiment, bone plate 910configured substantially similar to bone plate 10. The substantialdifference between bone plate 910 and bone plate 10 is that bone plate910 may include a hook portion 970. The hook portion 970 may beattached, integral with or other wise disposed at end of the secondportion 908. As was previously described with regards to second portion8 of bone plate 10, second portion 908 may be similarly substantiallycurved for conforming to the head of the bone, F, for example thefemoral head. The hook portion 970 includes a bone engaging edge 972 fordigging or penetrating into bone tissue. More specifically, the boneplate 910 may be located along the proximal femur bone F such thatsecond portion 908 may wrap around or conform to a portion of thegreater trochanter and the hook portion 970 may engage a region of thepiriformis. Bone engaging edge 972 may be configured for penetrating thebone surface to more effectively grip the bone F thereby permitting asurgeon to use bone plate 910 as a lever to resist the pull of muscleand tendons surrounding the broken segment of bone F and to properlyalign the bone F fragments. The depth at which the bone engaging edge972 penetrates the bone F may be limited by the interference of thegreater trochanter with the lower surface 922 of the bone plate 910.Once the bone F is properly aligned, bone screws engaged with andfixedly aligned by holes 924, 928, 934 may be inserted in the bone so asto fix bone plate 910 with respect to bone F.

Shown in FIG. 13, the hook portion 970 is configured so as to curveinward toward the first portion 906 of the bone plate 910 andterminating at a point beneath the lower surface 922 so as not tointerfere with a bone anchor engaged with the first hole 924. Shown inFIG. 14, the edge 972 may be preferably formed by two spaced aparttalons 973, 974 although other configuration are possible to facilitatethe secure engagement of hook 972 with the bone tissue.

Shown in FIGS. 15-27 are alternative embodiments of the bone platesconfigured for fixation of other long bones, for example, the tibia orhumerus. Referring to FIG. 15-17, shown is an alternative embodiment,bone plate 410 which includes upper surface 420, a lower surface 422, afirst section 401, which has a first longitudinal axis 402, and a secondsection 403, which has a second longitudinal axis 404. As with boneplate 10, the lower surface 422 of bone plate 410 may contact thesurface of the bone directly, or alternatively, at least a portion oflower surface 422 may be held at a distance from the bone surface tofacilitate increased flow of blood over the fracture zone. As seen inFIG. 15, recesses 412 may be provided along the lower surface 422 tofacilitate the flow of blood over the fracture zone. Referring now toFIG. 18, the bone plate 410 may further include a transition section 405connecting the first section 401 to the second section 403 in a mannersuch that the first longitudinal axis 402 and the second longitudinalaxis 404 define an angle λ in between. The first, second, and transitionsections 401, 403, 405 may be formed from a single piece of material,however other configurations are possible, for example, the pieces maybe welded or otherwise joined together. In addition, first, second andtransition sections 401, 403, 405 may have substantially the same widththroughout the bone plate, and may be substantially parallelogram inshape. However, other configurations are possible, for example, at leastone of the sections 401, 403, 405 may be flared or generally polygonalin shape.

Referring to FIG. 17, the bone plate may include at least a first hole424 and a second hole 428 having central axes 426, 428 respectively.First and second holes 424, 428 are configured in a substantiallysimilar manner to holes 24, 28 of bone plate 10, such that they arecapable of engaging a bone anchor, for example, the bone screw 100, thespiral blade 310 as previously described, or other types of bone anchorspreviously mentioned. It should be understood that first and secondholes 424, 428 may be configured for engaging the head of a bone anchorby threaded engagement, interference or press fitting, or any other formof joining the plate with the anchor heads known to one of ordinaryskill in the art. As shown, the first and second holes 424, 428 arepreferably configured so as to form respective locking threadedengagement with bone screws 510, 515, similar to bone screw 100, havingthreaded heads 506 (not shown), shafts 504 and tips 505. The first andsecond holes 424, 428 may include an internal thread and have a conicaltaper from the upper surface 420 to the lower surface 422. The lockedengagement fixes bone screws 510, 515 to the plate 410 such that shafts504 extend along the central axes 426, 430 of the holes 424, 428 in thebone plate 410. Additionally, the first and second holes 424, 428 arepreferably configured such that the central axes 426, 430 intersect at apoint 432 below the lower surface 422 of the bone plate 410. Thethreaded engagement of bone screws 510, 515 with the threaded first andsecond holes 424, 428 may form a truss 528 beneath the bone surface, ina manner as previously described with respect to bone plate 10. The bonescrew 510 may be substantially perpendicular to the lower surface 422 ofthe bone plate 410 or the exterior of the surface of the bone in whichit is inserted. The bone screw 515 may be at an acute angle with respectto the lower surface of the bone plate or the exterior of the bone inwhich it is inserted. Screw 515 may contact bone screw 510 at the tip105 of the bone screw 510, or anywhere along the shaft 104 of bone screw510. According to one illustrative embodiment, the angle formed by theintersection of central axes 426, 430 may range from between about 30°to about 60°, although other angles are possible.

The first and second holes 424, 428 may be located in the same sectionof the bone plate 410, or alternatively the first hole 424 may belocated in a section different from that of the second hole 428. Wherethe first and second hole 424, 428 are in the same section of the boneplate 410, the plane defined by the intersection of 426, 430 may becoplanar with a plane that bisects that same section of the bone plate410 where the first and second holes 424, 428 are located.Alternatively, the plane defined by the intersection of central axes426, 430 may be at an angle with respect to the plane that bisects boneplate 410 (not shown). The angle formed by the bisecting plane and theplane defined by intersecting central axes 426, 430 may range from about0° to about 60°, or range to about 15°, or range from about 3° to about6°.

A further embodiment, bone plate 610 shown in FIGS. 18-22, comprisesfirst and second holes 624, 628, shown in FIG. 21, having first andsecond central axes 626, 630 intersecting at 632. A still furtherembodiment, bone plate 810, shown in FIGS. 25-29 comprises first andsecond holes 824, 828, shown in FIG. 25, having central axes 826, 830intersecting 832. It is to be understood that first and second holes624, 628 of bone plate 610 and first and second holes 824, 828 of boneplate 810 may be variably configurable as first and second holes 424,428 of bone plate 410 described above. More specifically, the engagementof bone anchors with the plate 610 and/or 810 may fix the bone anchorsat a predetermined angle to form, respectively, truss 728, shown in FIG.21 and truss 1128, shown in FIG. 26, beneath the bone surface aspresently described with respect to bone plates 10 and 410. The firstand second bone screws may contact one another along their respectiveshafts or tips. In addition, bone plates 610 and 810 may selectively beanchored to bone such that their lower surfaces 622, 822 either contactthe bone surface directly, with or without recesses 612, 812 forfacilitating blood circulation over the fracture zone; or bone plates610, 810 may be spaced from the bone surface at a relative distance.

FIGS. 15-27 show bone plates 410, 610, 810 and the respectiveconnections of the first sections 401, 601, 801 and second sections 403,603, 803 by the transition section 405, 605, 805 in variousconfigurations; however, even other configurations are possible.Referring again to FIG. 16, the included angle λ formed between thefirst and second central axes 402, 404 may be obtuse, ranging from aboutan angle of 195° to about 175°, or 120° to 160°, or preferably angle λmeasures about 153°. Alternatively the included angle may besubstantially acute, ranging from an angle of about 15° to about 85°,preferably about 22°. Also, the angle λ may be a right angle, in whichthe second section 403 is substantially perpendicular to the firstsection 401.

As shown in FIGS. 15-27, the first and second sections of bone plates410, 610, 810 may have different lengths, e.g., the first section may belonger than the second section. The configurations are substantiallysimilar to those shown and described in U.S. Patent Publication2002/0183752 A1, the entire content of which is incorporated byreference thereto. Referring specifically to FIGS. 20 and 25, boneplates 610, 810 may, respectively, be substantially L-shaped orT-shaped. As shown in FIG. 19, the first section 601 may be located in aplane different from that of the second section 603. For instance,transition section 605 may be curved such that the lower surface 622 ofthe first section 601 is located in a first plane and the lower surface622 of the second section 603 is located in a second plane differentfrom the first plane. Alternatively or in addition thereto, thetransition section 605 may be twisted so that the lower surface 622 ofone side of the longitudinal axis 602, 604 is in a different from thatof the lower surface 622 of the other side of the longitudinal axis 602,604. This may be beneficial where the bone plates 410, 610, 810 have tobe located over a curved portion of a bone, such as the medial andlateral condyles of the proximal tibia.

Referring now to FIG. 23, shown is another bone plate 810 in which thetransition section 805 may define a third longitudinal axis 806 and maybe configured so as to define a first included angle λ₁ with the firstlongitudinal axis 802 of the first section 801 and a second includedangle λ₂ with the second longitudinal axis 804 of the second section803. The transition section 805, may be bent, curved or twisted aspreviously described, or additionally, the transition section 805 may betwisted such that the upper surface 820 is substantially S-shaped. Thefirst and second sections 401, 403; 601, 603; 801, 803 of bone plates410, 610, 810 may also be twisted or bent to conform to the bonesurface. For example, referring now to FIG. 20, shown is a cross-sectionview of the second section 603 of bone plate 610 in which the lowersurface 622 may be bent or curved along the second longitudinal axis604, so as to define a radius of curvature R. In addition, a portion ofthe first section 601 may be twisted about the first longitudinal axis602.

The bone plates 410, 610, 810 may also be provided with at least a thirdhole defining a third central axis, in which the third hole may bevariably configurable as the first and second holes 424, 428 previouslydescribed. The third hole may be engageable with the head or end portionof a bone anchor, for example bone screw 100 having a shaft 104 and tip105. Specifically referring to FIGS. 18 and 19, an illustrative example,bone plate 610 includes third hole 634 having central axis 636. Thirdhole 634 may be configured for threaded locked engagement with a bonescrew 100 so as to align the shaft 104 of bone screw 100 along the thirdcentral axis 636. The third central axis 636 of the third hole 634 maybe disposed at such an angle so as to intersect with at least one of thefirst and second central axes 626, 630 of the first and second holes624, 628. The third central axis 636 may be disposed at angle withrespect to the plane formed by first and second central axes 626, 630.

Shown in the FIGS. 21 and 22 is bone plate 610 engaged with bone screws710, 715, 720 respectively engaged with first, second and third holes624, 628, 634. Bone screws 710, 715 are threadedly engaged with firstand second holes 624, 628 to form truss 728 for rigidly anchoring thebone plate 610 to the fractured bone. The third bone screw 720, may bein threaded locked engagement with the bone plate 610 such that at leasta portion of the shaft 104 of the third bone screw 720, preferably thetip 105, may touch or nearly touch at least one of the shafts of thefirst or second bone screws 710, 715 so as to further reinforce thetruss 728 and the anchorage of bone plate 610. The third hole 634 may belocated in the same section of the bone plate as either of the first andsecond holes 624, 628. Alternatively, the third hole 634 may be locatedin a section different from that or those of either of the first andsecond holes 624, 628. For example, as shown in FIG. 21, the third hole634 is located in the transition section 605 with second hole 628. Firsthole 624 is located in the second section 603 of the bone plate 610.

As shown in FIGS. 15-27, bone plates 410, 610 and 810 may be providedwith any number of holes as may be suitable for a specific surgicalapplication. Any of these additional holes may be configured in a mannersimilar to and fully variable as first and second holes 424, 428 of boneplate 410, as previously described.

Referring now to FIGS. 21 and 22, the second section 603 of bone plate610 may include additional holes 640, 644, 648 having central axes 642,646, 650. As shown in FIG. 21, these additional holes may be configuredfor locked threaded engagement with heads 706 of bone screws 725, 730,735 having shafts 704, in which the shafts 704 align with central axes642, 646, 650. The central axes 642, 646, 650 may be disposed at suchangles with respect to the first and second central axes 626, 630, thatthe shafts of bone screws 725, 730, 735 either touch, almost touch orare substantially parallel to bone screws 710, 715, which are shownengaged with first and second holes 624, 628. Additional holes similarlyconfigured as 640, 644, 648 may be disposed in any of the first sections401, 601, 801, second sections 403, 603, 803, or transition sections405, 605, 805 of bone plates 410, 610, 810 as is necessary for the givensurgical application. Shown in the illustrative embodiment of FIG. 21,transition section 605 includes hole 652 engaged with bone screw 740.Alternatively, the screw holes in the bone plate 610, can be configuredsuch that a bone anchor, such as for example, conically threaded screw,can engage hole 624 and a second bone screw can engage hole 634 suchthat the screws contact or nearly contact to form a first trussstructure. Alternatively or in addition thereto a third bone screw canengage hole 628 and a fourth bone screw can engage hole 648 such thatthe third and fourth screws contact or nearly contact to form a secondtruss structure. Alternatively, first bone screw and third bone screwmay contact or nearly contact to form the first truss structure andsecond bone screw and fourth bone screw may contact or nearly contact toform the second truss structure. Alternatively or in addition, a fifthbone anchor may engage bone screw hole 652 and a sixth bone screw mayengage hole 644. The fifth and sixth bone screws may contact or nearlycontact to form yet a third truss structure.

First, second and third truss structures may be formed by any number ofcombinations of bone anchors in any number of configurations.Additionally, bone plate 610 may be provided with additional holes as isnecessary to form the desired number of truss structures. Moreover, thefirst, second, third and any additional truss structures may or may notcontact or nearly contact one or more of the other truss structures.Preferably, the second, third and additional truss structures may beangled so as to intersect a plane defined by the first truss structure.

Another example is shown in the embodiment of bone plate 410. In FIG.17, shown are holes 440, 444 disposed in the first section 401 spacedrelative to the first and second holes 424, 428 located in the secondsection 403 of bone plate 410. Holes 440, 444 may be preferablyconfigured for, respectively, threaded locked engagement with thethreaded heads 506 (not shown) of bone anchors 525, 530 such that theshafts 104 may diverge from one another and diverge from the shafts 504of bone fasteners 510, 515 engaged in first and second holes 424, 428.Another illustrative example is shown as the sixth embodiment, boneplate 810 in FIG. 25. First hole 824 is disposed in the second section803, second hole 828 is disposed in the first section 801. Referring toFIGS. 25 and 26, the third hole 834 is located in the transition section805 and is configured such that the shaft 1104 of bone screw 1120engaged with third hole 834, would touch or nearly touch one of theshafts 1104 of bone screws 1110, 1115 engaged in first and second holes824, 828. Additional holes 840, 844 are disposed in the second section803 and are configured so as to engage bone screws 1125, 1130 in such amanner that the shafts 1104 would align in a direction toward the bonescrews 1110, 1115 engaged in first and second holes 824, 828 so as toalmost touch.

Bone plates 410, 610, 810 may yet further include additional holes,threaded or unthreaded, for receiving additional bone anchors foranchoring the bone plates 410, 610, 810 to bone. For example, boneplates 410, 610, 810 may include a plurality of combination holes 438,638, 838, which are similar to the combination holes 38 described abovein reference to FIGS. 11A and 11B. The combination holes 438, 638, 838may all preferably be located in the first section 401, 601, 801 of thebone plates 410, 610, 810. Additionally, bone plates 410, 610, 810 mayinclude one or more holes configured for receiving a guide wire or otherinstrument, for example, hole 72, as shown in FIG. 2 for receiving aninstrument for applying compression to the fracture, or for example, asshown in FIG. 20, second section 603 includes a plurality of holes 618configured for receiving a guide wire or other instrument.

The bone plates 10, 910, 410, 610, and 810 may vary in both length andwidth, but generally the length exceeds the width so as to define agenerally longitudinal member. The length of the bone plates may rangefrom about 50 mm. to about 500 mm. Bone plate 10 may preferably range inlength from about 135 mm. to about 435 mm. Bone plate 910 may preferablyrange in length from about 145 mm. to about 480 mm. Bone plate 410 maypreferably range in length from about 75 mm. to about 235 mm. Bone plate610 may preferably range in length from about 81 mm. to about 240 mm.Bone plate 810 may preferably range in length from about 105 mm to about350 mm. Any section of bone plates 10, 910, 410, 610 and 810 may alsovary in width from about 5 mm. to about 10 mm. to about 18 mm. Where onesection of the bone plate is perpendicular to the other, the widest partof the bone plate may be as much as 35 mm. The thickness of the platesmay vary as well from approximately 3 mm to about 5 mm. In addition thebone plates may vary in thickness in along its length. For example,shown in FIG. 1 portion 6 of bone plate 10 generally has a taperedportion. First sections 406, 606 and 806 may also generally have atapered portion as well. All the bone plates discussed may have atapered portion elsewhere throughout the bone plate or alternatively,the plate thickness may vary in cross-section.

While preferred embodiments and features of the present invention havebeen disclosed herein, it will be appreciated that numerousmodifications and embodiments may be devised by those skilled in theart. It is intended that the appended claims cover all suchmodifications and embodiments as fall within the true spirit and scopeof such claims and that the claims not be limited to or by suchpreferred embodiments or features.

1. (canceled)
 2. A method comprising: mounting a bone plate to a bone,the bone plate having a body, the body defining an upper surface facingaway from the bone and a lower surface facing the bone, the bone platedefining 1) a first hole that extends through the body from the uppersurface to the lower surface along a first hole axis, and 2) a secondhole that extends through the body from the upper surface to the lowersurface; inserting a blade into the second hole, the blade defining aproximal end, a distal end and an axis that extends from the proximalend to the distal end, the blade further including a flute that extendsat least between the proximal end and the distal end; driving the bladethrough the second hole and into the bone; and attaching the proximalend of the blade to the bone plate, wherein the proximal end of theblade is sized such that, after the attaching step, the axis of theblade converges toward the first hole axis along a direction from theproximal end of the blade toward the distal end of the blade.
 3. Themethod of claim 2, wherein the proximal end of the blade is sized suchthat, after the attaching step, the axis of the blade intersects thefirst hole axis.
 4. The method of claim 3, wherein, after the attachingstep, the axis of the blade defines an acute angle with respect to thefirst hole axis.
 5. The method of claim 2, wherein the second hole axisextends through the body from the upper surface to the lower surfacealong a second hole axis that is angularly offset with respect to thefirst hole axis.
 6. The method of claim 5, wherein the second hole axisintersects the first hole axis.
 7. The method of claim 2, furthercomprising inserting a bone anchor into the first hole and along thefirst hole axis.
 8. The method of claim 7, wherein: the first hole isthreaded; the bone anchor includes a threaded head and a shaft thatextends from the threaded head; and the method further comprisesthreadedly attaching the threaded head of the bone anchor to the boneplate in the first threaded hole.
 9. The method of claim 7, wherein: thebone anchor includes a head and a shaft that extends from the head; andthe method further comprises press-fitting or interference-fitting thehead of the bone anchor to the bone plate in the first hole.
 10. Themethod of claim 7, wherein the bone anchor is a bone screw.
 11. Themethod of claim 7, wherein the bone anchor is sized such that the boneanchor contacts the blade when the bone anchor and the blade areattached to the bone plate in the first and second holes, respectively.12. The method of claim 2, wherein the flute is a spiral flute.
 13. Themethod of claim 2, wherein the blade includes a plurality of flutes thatextend at least between the proximal end and the distal end.
 14. Themethod of claim 2, wherein the blade defines an opening that extendstherethrough.
 15. The method of claim 14, wherein the opening extendsalong the axis of the blade.
 16. The method of claim 2, wherein the bodyof the bone plate extends along a longitudinal axis and defines a firstportion and a second portion, the second portion extends relative to thefirst portion along the longitudinal axis, the second portion has acurvature greater than a curvature of the first portion in a directionof extension along the longitudinal axis, the first hole extends throughthe second portion, and the second hole extends through the firstportion.
 17. The method of claim 16, wherein the first portion issubstantially planar, and the curvature of the second portion isconfigured to conform to the head of a long bone.
 18. The method ofclaim 2, wherein the bone plate includes a third hole that extendsthrough the body from the upper surface to the lower surface along athird hole axis.
 19. The method of claim 18, further comprising:inserting a head of a first bone anchor into the first hole, the firstbone anchor including a shaft that extends from the head and along thefirst hole axis; and inserting a head of a second bone anchor into thethird hole, the second bone anchor including a shaft that extends fromthe head of the second bone anchor and along the third hole axis. 20.The method of claim 18, wherein: the bone includes a head; the body ofthe bone plate defines a first portion and a second portion, the secondportion shaped to conform to the head of the bone, the second portionspaced from the first portion in a select direction; and each of thefirst and third holes is spaced from the second hole in the selectdirection.
 21. The method of claim 20, wherein, after the attachingstep, the axis of the blade converges toward each of the first hole axisand the third hole axis along the direction from the proximal end of theblade toward the distal end of the blade.